title: Predictive value of serial assessment of endothelial function in chronic heart failure.
abstract: BACKGROUND
  It remains undefined whether reversibility of endothelial dysfunction after optimized therapies for heart failure (HF) provides prognostic information in patients with HF. This study examined whether changes in endothelial vasomotor function after therapies for HF may predict future outcomes in patients with stable HF.
  
  
  METHODS
  This study included 245 patients with stable chronic ischemic HF and an impaired flow-mediated dilation (FMD) of the brachial artery (FMD <5.5%). Measurement of FMD was repeated after 6 months for individualized and optimized therapy for HF and atherosclerotic risk factors. Patients were followed for 36 months or until the occurrence of cardiac death or hospitalization with decompensated HF.
  
  
  RESULTS
  FMD was persistently impaired (<5.5%) in 130 (53%) patients after 6 months of the optimized therapy, whereas it improved (FMD ≥5.5%) in the remaining 115 (47%) patients. During follow-up, an event occurred in 26 (20%) patients with persistently impaired FMD and in 7 (6%) patients with improved FMD (p<0.01). Multivariate Cox hazards analysis showed that persistent impairment of FMD was an independent predictor of cardiac events (hazard ratio 3.0, 95% CI 1.3-6.9, p=0.013). Persistently impaired FMD had a significantly incremental effect on the predictability of brain natriuretic peptide levels for cardiac events. Baseline FMD before the therapy for HF and atherosclerotic risk factors had no significant prognostic information.
  
  
  CONCLUSIONS
  Persistent endothelial vasomotor dysfunction despite therapies for HF and atherosclerotic risk factors was a predictor of cardiac events in patients with chronic ischemic HF.
authors.affiliation: University of Yamanashi, Faculty of Medicine, Department of Internal Medicine II, Chuo, Yamanashi, Japan.
authors.forename: Isao
authors.initials: I
authors.lastname: Takishima
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Nakamura
authors.forename: Mitsumasa
authors.initials: M
authors.lastname: Hirano
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Kitta
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Daisuke
authors.initials: D
authors.lastname: Fujioka
authors.forename: Yukio
authors.initials: Y
authors.lastname: Saito
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Watanabe
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Hideto
authors.initials: H
authors.lastname: Mishina
authors.forename: Jyun-ei
authors.initials: JE
authors.lastname: Obata
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Kawabata
authors.forename: Shun
authors.initials: S
authors.lastname: Tamaru
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Kugiyama
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology*; D001916:Brachial Artery / Q000502:physiology; D002908:Chronic Disease; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D014664:Vasodilation / Q000502:physiology